Area Deprivation Index Research Articles

Fairness gaps in Machine learning models for hospitalization and emergency department visit risk prediction in home healthcare patients with heart failure

ObjectivesThis study aims to evaluate the fairness performance metrics of Machine Learning (ML) models to predict hospitalization and emergency department (ED) visits in heart failure patients receiving home healthcare. We analyze biases, assess performance disparities, and propose solutions to improve model performance in diverse subpopulations. MethodsThe study used a dataset of 12,189 episodes of home healthcare collected between 2015 and 2017, including structured (e.g., standard assessment tool) and unstructured data (i.e., clinical notes). ML risk prediction models, including Light Gradient-boosting model (LightGBM) and AutoGluon, were developed using demographic information, vital signs, comorbidities, service utilization data, and the area deprivation index (ADI) associated with the patient’s home address. Fairness metrics, such as Equal Opportunity, Predictive Equality, Predictive Parity, and Statistical Parity, were calculated to evaluate model performance across subpopulations. ResultsOur study revealed significant disparities in model performance across diverse demographic subgroups. For example, the Hispanic, Male, High-ADI subgroup excelled in terms of Equal Opportunity with a metric value of 0.825, which was 28% higher than the lowest-performing Other, Female, Low-ADI subgroup, which scored 0.644. In Predictive Parity, the gap between the highest and lowest-performing groups was 29%, and in Statistical Parity, the gap reached 69%. In Predictive Equality, the difference was 45%. Discussion and ConclusionThe findings highlight substantial differences in fairness metrics across diverse patient subpopulations in ML risk prediction models for heart failure patients receiving home healthcare services. Ongoing monitoring and improvement of fairness metrics are essential to mitigate biases.

Association of Area Deprivation Index with Prostate Cancer Incidence Outcomes in a Contemporary North American Cohort

Introduction: Socio-economic status and geographical location contribute to disparities in prostate cancer (PCa) outcomes, which are particularly evident for Non-Hispanic Black (NHB) men. The Area of Deprivation Index (ADI) could offer a distinctive and valuable metric for measuring the impact of these factors in underprivileged areas on disparities in cancer outcomes. Our study examined the impact of ADI on Prostate Cancer (PCa) incidence and lethality over a contemporary North American population. Methods: Our institutional database included electronic medical records for all men who received at least one PSA test within Henry Ford Health (HFH), between 1995-2019. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. All patients were further categorized into ADI quartile, where the highest quartile (Q4: 75-100) represented individuals with the most disadvantageous socio-economic status. The main outcomes were PCa incidence and lethal PCa, defined as any metastatic PCa or death due to PCa occurred within our cohort. Competing-risk cumulative incidence and multivariable regression tested the impact of ADI on PCa outcomes. A formal ADI x race interaction term was introduced to examine whether the relationship between ADI and PCa outcomes varies between NHB and NHW men. Results: We included 134,366 patients, 25% of whom were NHB. Median follow-up was 8.8 years. When NHB patients were categorized based on their ADI quartile, the 20-years PCa incidence rates were 11.5%, 13.5%, 12.6% and 12.1% (p=0.009) for the first, second, third and fourth quartile respectively. For the same quartiles, 20-years incidence rates in NHW were 8.8%, 7.8%, 6.8% and 5.4% (p <0.001). Lethal PCa rates for these quartiles were 2.0%, 1.4%, 1.2% and 2.3% (p<0.001) in NHB, versus 0.92%, 0.79%, 0.93% and 1.2% (p=0.140) in NHW. At multivariate analysis, individuals from the third (ADI 50-74, HR: 0.89, 95% CI: 0.83-0.95) and the fourth quartile (ADI ≥ 75, HR: 0.80, 95% CI: 0.75-0.86) showed significant reduced HRs for PCa incidence, when compared with the first quartile (ADI<25, all p<0.001). NHB (vs NHW) men were persistently at higher hazard for both PCa incidence and lethality accross all ADI strata (all p<0.001), although the interaction term was significant only for PCa incidence Conclusions: Our study is the first comprehensive evaluation of the association between neighborhood deprivation and race in PCa outcomes in a contemporary North American cohort. Living in more deprived areas was associated with a lower hazard for PCa incidence but not for lethality, although individuals in the highest ADI quartiles showed the worst lethal disease rates. NHB men persistently exhibited worse oncological outcomes, when compared with NHW individuals. This racial disparity became more prominent with an increase in ADI, but this trend was observed only for incidence.

Association of Area Deprivation Index with Adherence to Proposed Regimen in Patients with Sarcoidosis in Detroit, Michigan.

Social predictors affect severity of sarcoidosis, with Black patients, older individuals, those with lower income, and those without insurance having greater severity. This study aimed to explore potential disparities affecting access to care in sarcoidosis patients with a primary focus on metrics such as area deprivation index (ADI) and its association with adherence to the proposed regimen. A retrospective chart review study of all patients seen in pulmonary clinics at a large urban tertiary care center over 2 years with sarcoidosis patients identified with International Classification of Diseases diagnosis code D86. Data collected included age, race, sex, ADI, insurance, online patient portal usage, chest x-rays, pulmonary function tests, missed visits, hospitalizations, positive biopsy, communication and visits around bronchoscopy. Categorical variables were described using frequency and percentage. Numerical variables were described using median, mean and standard deviation. Statistical analysis included chi-square test, two-sample T-test and Wilcoxon rank sum test. Multivariate logistic regression analysis was performed to model independent association with 12 month no-show occurrence as a metric of adherence to the proposed regimen. Among sarcoidosis patients (N = 788), univariate models showed the presence of active online patient portal use among younger patients (58.6 years with portal vs. 65.1 years without portal, p < 0.001), those with lower ADI (73 with portal vs. 92 without portal, p < 0.001) and with commercial insurance (48.5% with portal vs. 20.7% without portal, p < 0.001); more x-rays (45.6% with x-rays vs. 36.6% without x-rays, p = 0.018) and hospitalizations (50.3% with hospitalizations vs. 36.2% without hospitalizations, p < 0.001) in Medicare patients. Sarcoidosis patients with positive biopsies on file from 2013-2023 were more likely to be male (44.19% with positive biopsy vs. 33.91% without positive biopsy, p = 0.006), White (36.29% with positive biopsy vs. 22.9% without positive biopsy, p < 0.001) or other races (3.23% with positive biopsy vs. 2.25% without positive biopsy, p < 0.001), younger (55.8 years with positive biopsy vs. 61.7 years without positive biopsy, p < 0.001) and belonged to lower national ADI ranks (73 with positive biopsy vs. 80 without biopsy, p = 0.041). A multivariate analysis was done with those variables found to be significant in the univariate analyses, which revealed that higher ADI national was associated with failure to adhere to the proposed regimen. We identified intricate patterns of sociodemographic variables affecting access to care in sarcoidosis patients, especially higher ADI national associated with failure to adhere to the proposed regimen, raising concerns for potential healthcare barriers. Understanding these barriers is vital for equitable high-quality care, assisting in timely and efficient management of the patient's disease.

The Impact of Social Deprivation on Health Care Utilization Patterns Following Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures

BackgroundDisparities in social determinants of health have been linked to worse patient reported outcomes, higher postoperative pain, and increased risk of revision surgery following orthopaedic procedures. Identification of perioperative predictors of healthcare utilization is of particular interest to mitigate cost and improve patient outcomes. The aim of this study is to elucidate the effect of social deprivation levels, using the Area Deprivation Index (ADI), on healthcare utilization following pinning of supracondylar humerus (SCH) fractures. Identifying risk factors for discrepancies in healthcare utilization following SCH fracture fixation can help mitigate unnecessary healthcare spending and improve care of vulnerable patient populations. MethodsThis is a retrospective review of a single institution’s experience with SCH fracture pinning between 2010 and 2023. Demographic variables and healthcare utilization data were recorded within 90 days of surgery. The ADI was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared. Results1186 patients from a single level one trauma center were included in this study. The upper, middle, and lower terciles of ADI consisted of 226, 458, and 502 patients, respectively. The most deprived tercile had greater emergency department visitation within 90 days of surgery relative to the least and intermediate deprived terciles (IRR 1.85, 95% CI 1.10-3.08). Identifying as White was an independent risk factor for increased outpatient clinic utilization (IRR 1.17, 95% CI 1.03-1.34). Higher levels of social deprivation were independent risk factors for increased ED visitation. There was no difference in 90-day inpatient readmission rates or telephone/telehealth calls made to the clinic between the least, intermediate, and most deprived patients. ConclusionsThis study begins to shed light on how social determinants of health impact the postoperative care of the pediatric orthopedic patient and which patient populations are the most at-risk for disproportionate resource utilization after pinning of SCH fractures. Understanding these differences may lead to improved patient outcomes while decreasing potentially unnecessary burden on the healthcare system. Level of EvidenceIII; retrospective comparative study Key Concepts1.Social determinants of health impact the postoperative care of the pediatric patient in the setting of supracondylar humerus fractures, more socially deprived patients are at higher risk of postoperative emergency department visits, patient race is shown to be a factor in postoperative clinic utilization.

Early Kidney Transplantation or Conversion to Peritoneal Dialysis after First-Time Arteriovenous Access Creation

After autogenous arteriovenous (AV) access creation for end-stage renal disease, a majority of patients will continue on hemodialysis (HD), a minority will receive definitive treatment with kidney transplantation, and a subset of patients will convert to peritoneal dialysis (PD). Our goal was to identify patient factors associated with early transition from HD to either kidney transplantation or PD. This is a case-control study of all patients with first-time AV access creation in the Vascular Quality Initiative (2011-2022) who had long-term follow-up. Patients who remained on HD after AV access creation were the control group while patients who received early kidney transplant or who converted to PD were the 2 case groups. Relationship among demographics, comorbidities, neighborhood social disadvantage, and functional status as they relate to renal replacement therapy modality was assessed. There were 19,782 patients included; the average age was 62±15years and 57% were male. During the follow-up period of a median 306 (71-403) days, 1.3% underwent a kidney transplantation and 2.3% underwent conversion to PD. On univariable analysis, rates of kidney transplantation or conversion to PD varied with race (P<0.001), insurance status (P<0.001), area deprivation index (ADI) quintile (P<0.001), and several medical comorbidities. On multivariable analysis, impaired ambulation, current smoking, Medicaid or Medicare insurance, Black race, heart failure, body mass index, and older age were associated with decreased transplantation rates. Conversion to PD was associated with ADI Q5, Q4, and Q3. Decreased conversion to PD was associated with impaired ambulation, Hispanic ethnicity, Black race, former smoking, medication-controlled diabetes, and older age. Decreased kidney transplantation was associated with Black race and noncommercial health insurance but not ADI quintile, suggesting disparities exist beyond community-level access to care. Early kidney transplantation conveyed a 3-year survival benefit compared with HD and PD, which had similar survival. Furthermore work is required to increase access to kidney transplantation and PD.

Investigating the relationships between motor skills, cognitive status, and area deprivation index in Arizona: a pilot study.

Previous studies highlight the negative impact of adverse socioeconomic conditions throughout life on motor skills and cognitive health. Factors such as cognitive activity, physical activity, lifestyle, and socioeconomic position significantly affect general health status and brain health. This pilot study investigates the relationships among the Area Deprivation Index (ADI)-a measure of neighborhood-level socioeconomic deprivation, brain structure (cortical volume and thickness), and cognitive status in adults in Arizona. Identifying measures sensitive to ADI could elucidate mechanisms driving cognitive decline. The study included 22 adults(mean age = 56.2 ± 15.2) in Arizona, residing in the area for over 10 years(mean = 42.7 ± 15.8). We assessed specific cognitive domains using the NeuroTrax™ cognitive screening test, which evaluates memory, executive function, visual-spatial processing, attention, information processing speed, and motor function. We also measured cortical thickness and volume in 10 cortical regions using FreeSurfer 7.2. Linear regression tests were conducted to examine the relationships between ADI metrics, cognitive status, and brain health measures. Results indicated a significant inverse relationship between ADI metrics and memory scores, explaining 25% of the variance. Both national and state ADI metrics negatively correlated with motor skills and global cognition (r's < -0.40, p's < 0.05). In contrast, ADI metrics generally positively correlated with motor-related volumetric and cortical thickness measures (r's > 0.40, p's < 0.05). The findings suggest that neighborhood-level social deprivation might influence memory and motor status, primarily through its impact on motor brain health.

Engagement Among Diverse Patient Backgrounds in a Remote Symptom Monitoring Program.

Previous randomized controlled trials have demonstrated benefit from remote symptom monitoring (RSM) with electronic patient-reported outcomes. However, the racial diversity of enrolled patients was low and did not reflect the real-world racial proportions for individuals with cancer. This secondary, cross-sectional analysis evaluated engagement of patients with cancer in a RSM program. Patient-reported race was grouped as Black, Other, or White. Patient address was used to map patient residence to determine rurality using Rural-Urban Commuting Area Codes and neighborhood disadvantage using Area Deprivation Index. Key outcomes included (1) being approached for RSM enrollment, (2) declining enrollment, (3) adherence with RSM via continuous completion of symptom surveys, and (4) withdrawal from RSM participation. Risk ratios (RR) and 95% CI were estimated from modified Poisson models with robust SEs. Between May 2021 and May 2023, 883 patients were approached to participate, of which 56 (6%) declined RSM. Of those who enrolled in RSM, a total of 27% of patients were Black or African American and 67% were White. In adjusted models, all patient population subgroups of interest had similar likelihoods of being approached for RSM participation; however, Black or African American patients were more than 3× more likely to decline participation than White participants (RR, 3.09 [95% CI, 1.73 to 5.53]). Patients living in more disadvantaged neighborhoods were less likely to decline (RR, 0.49 [95% CI, 0.24 to 1.02]), but less likely to adhere to surveys (RR, 0.81 [95% CI, 0.68 to 0.97]). All patient populations had a similar likelihood of withdrawing. Black patients and individuals living in more disadvantaged neighborhoods are at risk for lower engagement in RSM. Further work is needed to identify and overcome barriers to equitable participation.

Analysis of travel burden and travel support among patients treated at a comprehensive cancer center in the Southeastern United States.

Travel burden leads to worse cancer outcomes. Understanding travel burden and the level and types of travel support provided at large cancer centers is critical for developing systematic programs to alleviate travel burden. This study analyzed patients who received travel assistance, including their travel burden, types and amount of travel support received, and factors that influenced these outcomes. We analyzed 1063 patients who received travel support from 1/1/2021 to 5/1/2023 at Winship Cancer Institute, in which ~18,000 patients received cancer care annually. Travel burden was measured using distance and time to Winship sites from patients' residential address. Travel support was evaluated using the monetary value of total travel support and type of support received. Patients' sociodemographic and clinical factors were extracted from electronic medical records. Area-level socioeconomic disadvantage was coded by the Area Deprivation Index using patient ZIP codes. On average, patients traveled 57.2 miles and 67.3min for care and received $74.1 in total for travel support. Most patients (88.3%) received travel-related funds (e.g., gas cards), 5% received direct rides (e.g., Uber), 3.8% received vouchers for taxi or public transportation, and 3% received combined travel support. Male and White had longer travel distance and higher travel time than female and other races, respectively. Patients residing in more disadvantaged neighborhoods had an increased travel distance and travel time. Other races and Hispanics received more travel support ($) than Black and White patients or non-Hispanics. Patients with higher travel distance and travel time were more like to receive travel-related financial support. Among patients who received travel support, those from socioeconomically disadvantaged neighborhoods had greater travel burden. Patients with greater travel burden were more likely to receive travel funds versus other types of support. Further understanding of the impact of travel burden and travel support on cancer outcomes is needed.

Area deprivation index and social vulnerability index in Milwaukee County: Impact on hospital outcomes after traumatic injuries

BackgroundPredisposing factors for traumatic injuries are complex and variable. Neighborhood environments may influence injury mechanism or outcomes. The Social Vulnerability Index (SVI) identifies areas at risk for emergencies; Area Deprivation Index (ADI) measures socioeconomic disadvantage. The objective was to assess the impact of SVI or ADI on hospital length of stay (LOS) and mortality for injured patients to determine whether SVI or ADI indicated areas where injury prevention may be most impactful. MethodsAdult patients who resided in Milwaukee County and were treated for injuries from 2015 to 2022 at a level I trauma center were included. Patients’ addresses were geocoded and merged with 2020 state-level SVI and ADI measures. SVI ranks census tracts 0–100 from least to most vulnerable. ADI ranks census block groups 1–10 from least to most disadvantaged. ADI and SVI rankings were converted to deciles. Statistical analyses included descriptive statistics, chi-square tests, and regression models for LOS and in-hospital mortality, adjusted for either SVI or ADI within separate models, age, sex, race or ethnicity, mechanism of injury (MOI), injury severity score (ISS). Results14,542 patients were included; 63 % were male. Mean total hospital LOS was 6.4 ± 9.8 days, and in-hospital mortalities occurred in 5.2 % of patients. Based on SVI and ADI, 5,280 (36 %) patients resided in high vulnerability areas and 5,576 (39 %) lived in highly disadvantaged areas, respectively. After adjusting for patient factors, SVI deciles #6, 9, 10 were associated with increased hospital LOS, and SVI decile #5 was associated with in-hospital mortality (OR = 2.22, 95 %CI:1.06–4.63; p = 0.034). When adjusted for ADI, the 7th-10th deciles were associated with increased hospital LOS. Greater age and ISS were associated with increased hospital LOS and mortality when adjusted for SVI and ADI. ConclusionsSVI and ADI identified a similar proportion of patients in high vulnerability or disadvantaged areas. Higher SVI and ADI deciles were associated with longer hospital LOS, and only the 5th SVI decile was associated with in-hospital mortality. Highly disadvantaged or vulnerable areas may have a longer LOS, but SVI and ADI have limited influence on trauma mortality. Continued research on neighborhood and community factors and trauma outcomes is needed.

Residential proximity to toxic metal-emitting industrial sites and toenail metal concentrations in a United States-wide prospective cohort

BackgroundIndustrial facilities across the United States (US) release millions of pounds of toxic chemicals, including metals. Exposure to toxic metals has been associated with adverse health outcomes, but there is limited evidence on the association between living near metal-releasing facilities and the body burden of emitted compounds. ObjectiveTo investigate the association between residential proximity to toxic metal-emitting industrial facilities and toenail metal concentrations and to evaluate whether associations differed by race. MethodsIn a sample of 1556 non-Hispanic Black (32.5%) and non-Hispanic White (67.5%) women from the Sister Study, we used the US Environmental Protection Agency Toxics Release Inventory to identify metal-emitting facilities within 3, 5, and 10 km of participants’ baseline residences. We measured toenail concentrations (μg/g) of arsenic, cadmium, cobalt, chromium, and lead. Using multivariable linear regression, we examined associations between residential proximity to and emissions from metal-emitting facilities and toenail metal concentrations, stratifying by race. We explored modification of race-stratified associations by neighborhood deprivation, using the Area Deprivation Index (ADI). ResultsBlack participants were more likely to reside within 3 km of chromium-releasing facilities and 5 and 10 km of all observed metal-emitting sites. Living near metal-releasing facilities was not associated with higher toenail metal concentrations overall. Among Black women, higher chromium emissions exposure was associated with higher toenail chromium levels (βTertile3vs.non-exposed = 2.36 μg/g, 95% CI = 0.63, 4.10). An association with lead was observed among Black women residing in the most deprived areas (≥75th ADI percentile: β = 3.08 μg/g, 95% CI = 1.46, 4.71). No associations were observed for White participants. ConclusionsDespite low exposure prevalence, our findings suggest that living near chromium- and lead-releasing facilities, especially at shorter distances, may be associated with higher corresponding toenail metal levels among Black women, particularly those residing in the most disadvantaged areas.

How multidisciplinary clinics may mitigate socioeconomic barriers to care for chronic limb-threatening ischemia

ObjectiveAlthough multidisciplinary clinics improve outcomes in chronic limb-threatening ischemia (CLTI), their role in addressing socioeconomic disparities is unknown. Our institution treats patients with CLTI at both traditional general vascular clinics and a multidisciplinary Limb Preservation Program (LPP). The LPP is in a minority community, providing expedited care at a single facility by a consistent team. We compared outcomes within the LPP with our institution’s traditional clinics and explored patients’ perspectives on barriers to care to evaluate if the LPP might address them. MethodsAll patients undergoing index revascularization for CLTI from 2014 to 2023 at our institution were stratified by clinic type (LPP or traditional). We collected clinical and socioeconomic variables, including Area Deprivation Index (ADI). Patient characteristics were compared using χ2, Student t, or Mood median tests. Outcomes were compared using log-rank and multivariable Cox analysis. We also conducted semi-structured interviews to understand patient-perceived barriers. ResultsFrom 2014 to 2023, 983 limbs from 871 patients were revascularized; 19.5% of limbs were treated within the LPP. Compared with traditional clinic patients, more LPP patients were non-White (43.75% vs 27.43%; P < .0001), diabetic (82.29% vs 61.19%; P < .0001), dialysis-dependent (29.17% vs 13.40%; P < .0001), had ADI in the most deprived decile (29.38% vs 19.54%; P = .0061), resided closer to clinic (median 6.73 vs 28.84 miles; P = .0120), and had worse Wound, Ischemia, and foot Infection (WIfI) stage (P < .001). There were no differences in freedom from death, major adverse limb event (MALE), or patency loss. Within the most deprived subgroup (ADI >90), traditional clinic patients had earlier patency loss (P = .0108) compared with LPP patients. Multivariable analysis of the entire cohort demonstrated that increasing age, heart failure, dialysis, chronic obstructive pulmonary disease, and increasing WIfI stage were independently associated with earlier death, and male sex was associated with earlier MALE. Ten traditional clinic patients were interviewed via convenience sampling. Emerging themes included difficulty understanding their disease, high visit frequency, transportation barriers, distrust of the health care system, and patient-physician racial discordance. ConclusionsLPP patients had worse comorbidities and socioeconomic deprivation yet had similar outcomes to healthier, less deprived non-LPP patients. The multidisciplinary clinic’s structure addresses several patient-perceived barriers. Its proximity to disadvantaged patients and ability to conduct multiple appointments at a single visit may address transportation and visit frequency barriers, and the consistent team may facilitate patient education and improve trust. Including these elements in a multidisciplinary clinic and locating it in an area of need may mitigate some negative impacts of socioeconomic deprivation on CLTI outcomes.

QOL-52. SOCIOECONOMIC METRICS AND THEIR UNIQUE ROLE IN PREDICTING COGNITIVE AND FUNCTIONAL MORBIDITY IN RACIALLY AND ETHNICALLY DIVERSE PATIENTS WITH PEDIATRIC BRAIN TUMOR (PBT)

Abstract BACKGROUND Caregivers from more advantaged backgrounds have better understanding of their child’s needs, access to resources, and medical adherence, contributing to higher survival and neuropsychological (NP) outcomes in PBT, above and beyond diagnostic/treatment-related factors. Children with PBT from disadvantaged neighborhoods have increased medical morbidity, though cognitive morbidity is unknown. This study examines area deprivation index (ADI) quintiles (neighborhood disadvantage) in relation to established proxies for socioeconomic status (SES) and NP outcomes following PBT diagnosis. METHODS Parental education and median household income (SES proxies), as well as ADI quintiles (1-5, 5=most disadvantaged) were estimated for 120 PBT patients (ages 5-21; x̄=13.6 years, SD=3.8 years; 50% female). NP outcomes included estimated IQ (calculated from Wechsler Vocabulary/Matrix Reasoning) and/or the Adaptive Behavior Assessment System-Third Edition (ABAS-3). RESULTS Over 75% identified as minorities (53% Latinx, 10% Asian American, 5% Black, 8% multi/other). Findings revealed significant racial/ethnic disparities in household income [F(4,115)=11.208, p&amp;lt;.001] and ADI [F(4,108)=9.663, p&amp;lt;.001]. Parental education was correlated with household income [rs(80)=.490, p&amp;lt;.001] and ADI [rs(76)=-.477, p&amp;lt;.001]. Interestingly, household income [F(1,74)=7.498, p=.008] and parental education [F(1,49)=10.084, p=.003] significantly predicted IQ (SS=44-132; x̄=99.78, SD=14.66), while ADI did not. Neither SES proxy nor ADI predicted adaptive functioning (SS=51-120; x̄=90.12, SD=13.927), despite the relationship between IQ and adaptive functioning, r(47)=.273, p=.032. CONCLUSIONS The predictive value of household income (which varies by race/ethnicity) and parental education on cognition following PBT diagnosis continues to inform neuropsychological practice. While ADI is correlated with both established SES proxies, higher neighborhood disadvantage does not predict cognitive concerns in the same way, indicating potential unique housing factors (e.g., persons per room ratio) that may protect against cognitive morbidity (e.g., multigenerational living). Additional investigation is needed to understand why adaptive functioning is less susceptible to SES/ADI than cognition.

Associations of role, area deprivation index, and race with health behaviors and body mass index among localized prostate cancer patients and their partners.

To examine the associations of role (localized prostate cancer (PCa) patient vs. their intimate partner), area deprivation index (ADI-higher scores indicating higher neighborhood deprivation levels), and race (Black/African American (AA) vs. White) with health behaviors and body mass index (BMI) among PCa patients and partners. The behaviors include smoking, alcohol consumption, diet quality, sedentary behaviors, and physical activity (PA). This study used the baseline data collected in a clinical trial. Given the nested structure of the dyadic data, multi-level models were used. Significant role-race interaction effects on smoking, ADI-race effects on alcohol consumption, and role-ADI effects on BMI were found. Meanwhile, patients smoked more cigarettes, decreased alcohol consumption, had less healthful diets, spent longer time watching TV, did fewer sedentary hobbies, had more confidence in PA, and had higher BMIs than their partners. High ADI was independently associated with lower odds of drinking alcohol, using computer/Internet, and doing non-walking PA, and higher BMI compared to low ADI controlling for role and race. Black/AA dyads had less smoking amount and alcohol consumption and higher sedentary time and BMI than White dyads when adjusted for role and ADI. This study identified significant interaction and main effects of role, ADI, or race on health behaviors and BMI. Future behavioral interventions should address divergent individual needs between patients and partners, social and neighborhood barriers, and cultural indicators of racial groups to promote healthful behaviors and improve the quality of survivorship for PCa patients and partners.

QOL-45. SOCIAL DETERMINANTS OF HEALTH PREDICT NEUROPSYCHOLOGICAL OUTCOMES IN PEDIATRIC BRAIN TUMOR SURVIVORS

Abstract BACKGROUND Pediatric brain tumors and their treatment impact cognition including intellectual functioning (IQ), attention, working memory, and processing speed. Few studies have examined the role of social determinants of health (SDoH) on cognition in pediatric brain tumors. To date, studies have primarily focused on family-related SDoH factors such as insurance status or parental education as predictors of cognition. To our knowledge, no study has examined multiple indicators of SDoH to determine which family-based and community-based predict cognition. METHODS Participants included 151 pediatric brain tumor patients (M diagnosis age=8.82) seen for a clinical neuropsychological evaluation (M evaluation age=13.71). IQ, brief attention (WISC/DAS-II Digits Forward), working memory (WISC/DAS-II Digits Backwards), and processing speed (WISC Coding) were obtained from age-appropriate measures (WISC&amp;gt;6 years, DAS-II&amp;lt;6 years). Family-based SDoH indicators include insurance type (public, private) and maternal education (&amp;lt;high school degree, some college, ≥college degree). Community-based SDoH include the Area Deprivation Index (ADI) and Childhood Opportunity Index (COI). Multiple regressions examined variance in IQ, attention, working memory, and processing speed accounted for by the SDoH measures, after controlling for treatment exposures using the Neurological Predictor Scale. RESULTS Insurance accounted for 14.9% of the IQ variance [β=-.316, t(151)=-4.18; p&amp;lt;.001]; COI accounted for 18.3% of the IQ variance [β=.202, t(151)=2.70; p=.008]. Insurance accounted for 12% of the variance in attention [β=-.324, t(152)=-4.22; p&amp;lt;.001], and 17.5% of the variance in processing speed [F(2,134)=15.399, p&amp;lt;.001]. In the working memory model, insurance [β=-.179, t(148)=-2.19; p=.03] and ADI [β=-.171, t(148)=-2.11; p=.04], accounted for 5.3% and 7.5% of the variance, respectively. CONCLUSIONS Findings highlight the important contribution of both family and community factors on neuropsychological outcomes in pediatric brain tumors. Nuances of the data will be discussed as they relate to clinical care and research.

Understanding racial differences in financial hardship among older adults surviving cancer.

Despite Medicare coverage, financial hardship is a prevalent issue among those diagnosed with cancer at age 65 years and older, particularly among those belonging to a racial or ethnic minority group. Sociodemographic, clinical, and area-level factors may mediate this relationship; however, no studies have assessed the extent to which these factors contribute to the racial/ethnic disparities in financial hardship. Surveys assessing financial hardship were completed by 721 White (84%) or Black (16%) patients (aged 65 years and older) who were diagnosed with breast (34%), prostate (27%), lung (17%), or colorectal (14%) cancer or lymphoma (9%) at the University of Alabama at Birmingham between 2000 and 2019. Financial hardship included material, psychological, and behavioral domains. Nonlinear Blinder-Oaxaca effect decomposition methods were used to evaluate the extent to which individual and area-level factors contribute to racial disparities in financial hardship. Black patients reported lower income (65% vs. 34% earning <$50,000) and greater scores on the Area Deprivation Index (median, 93.0 vs. 55.0). Black patients reported significantly higher rates of overall (39% vs. 18%), material (29% vs. 11%), and psychological (27% vs. 11%) hardship compared with White patients. Overall, the observed characteristics explained 51% of racial differences in financial hardship among cancer survivors, primarily because of differences in income (23%) and area deprivation (11%). The current results identify primary contributors to racial disparities in financial hardship among older cancer survivors, which can be used to develop targeted interventions and allocate resources to those at greatest risk for financial hardship.

QOL-43. COMPARISON OF SOCIAL DETERMINANTS OF HEALTH MEASURES ON IQ AND ACADEMIC OUTCOMES IN PEDIATRIC BRAIN TUMORS

Abstract BACKGROUND Treatment for pediatric brain tumors impacts IQ and academic achievement; fewer studies have examined the role of social determinants of health (SDoH). To date, studies have primarily focused on family-based SDoH such as insurance type or parental education as predictors of cognition. Limited studies have examined community factors, though our work highlighted the role of education quality on IQ and academics in pediatric brain tumors. To our knowledge, no study has examined the predictive value of family and community-based SDoH. METHODS Participants included 151 pediatric brain tumor patients (M age at diagnosis=8.82) seen for a clinical neuropsychological evaluation (M age at evaluation=13.71). IQ was obtained from age-appropriate intelligence measures (WISC&amp;gt;6 years, DAS-II&amp;lt;6 years); untimed reading and math calculation were examined via WIAT/KTEA/WJ subtests. Family-based SDoH included insurance type (public, private) and maternal education (&amp;lt;high school degree, some college, &amp;gt;college degree). Community-based SDoH included the Area Deprivation Index (ADI) and Education, Health-Environment, and Social-Economic indices from the Childhood Opportunity Index (COI). Multiple regressions examined variance in IQ, reading, and math accounted for by each of the SDoH measures, after controlling for treatment exposures using the Neurological Predictor Scale (NPS). RESULTS Insurance [β=-.302, t(151)=-4.00; p&amp;lt;001] and Education [β=.235, t(151)=3.14; p=.002] accounted for 14.9% and 19.7% of the IQ variance, respectively. Education also accounted for 12.8% of the reading variance (β=.304, t(109)=3.40; p&amp;lt;.001). Both the Education [β=.570, t(107)=3.41; p&amp;lt;.001] and Social-Economic [β=-.381, t(107)=-2.28; p=.03] indices accounted for 7.7% and 11.3% of the math calculation variance, respectively. CONCLUSIONS Community, particularly those related to education and social &amp; economic resources, and family factors (e.g., insurance status) were associated with IQ and academic performance. Findings indicate the importance of investigating both family and community factors that may contribute to outcomes in pediatric brain tumors.

Patient Preferences for Immediate Compared With Delayed Postpartum Intrauterine Device Placement.

To use choice-based conjoint survey methodology to evaluate patient values and decision making regarding immediate compared with delayed placement of postpartum intrauterine devices (IUDs). We conducted a cross-sectional study in which we surveyed 200 nonpregnant, parous patients. Participants chose between hypothetical postpartum IUDs varying in multiple attributes (hormonal or nonhormonal IUD type, placement timing, 1-year efficacy, expulsion risk, risk of lost strings, and malposition risk). The primary outcome was preference for immediate compared with delayed postpartum IUD placement and importance of placement timing relative to other attributes. Secondarily, we evaluated whether demographic and neighborhood characteristics were associated with timing preference and attribute importance. We included 190 participants for analysis. Most participants (62.6%) preferred delayed placement. There was no significant difference in timing preference by race ( P =.28) or block-level Area Deprivation Index score ( P =.27). Patients who preferred immediate placement were more likely to have public insurance than private insurance (70.4% vs 29.6%, P =.04); however, the majority of patients (55.1%) with public insurance still preferred delayed placement. Attributes of IUD type, malposition risk, 1-year efficacy, and expulsion risk all had greater effects on patient decision making than placement timing. There was no difference in attribute importance by race ( P =.30), Area Deprivation Index score ( P =.88), or insurance type ( P =.22). Patients preferred the higher efficacy and lower complication rates of delayed postpartum IUD placement over the convenience of immediate placement. Insurance considerations may affect these timing preferences. There was no difference in attribute importance between demographic groups or based on neighborhood-level factors, indicating that, although both immediate and delayed postpartum IUD placement should be offered, counseling should not vary according to individual demographic characteristics.

Neighborhood socioeconomic disadvantage does not predict need for manipulation under anesthesia or range of motion following total knee arthroplasty

BackgroundStudies have linked socioeconomic factors including lower income and minority race with worse functional outcomes following total knee arthroplasty (TKA). Arthrofibrosis is a common complication following TKA, and manipulation under anesthesia (MUA) is an effective treatment option for arthrofibrosis. This study aimed to determine if neighborhood-level socioeconomic disadvantage predicts need for MUA and postoperative range of motion (ROM) among patients undergoing primary elective TKA. MethodsWe performed a retrospective cohort study of primary TKAs performed at a single institution over a three-year duration. Area Deprivation Index (ADI) was used to determine each patient's level of socioeconomic disadvantage based on their home address. Patients were allocated into three groups based on ADI: least socioeconomic disadvantage (ADI 1–3), middle socioeconomic disadvantage (ADI 4–6), and most socioeconomic disadvantage (ADI 7–10). Demographic factors and comorbid conditions were recorded. Bivariate analysis was used to evaluate the relationship between degree of socioeconomic disadvantage and need for MUA and postoperative ROM. ResultsIn total, 600 patients were included and 26.7 % were categorized as most disadvantaged. In comparison to the middle and least disadvantaged groups, these patients were more likely to be Women (71.2 vs. 67.9 and 58.6 %; p = 0.027), younger (60.7 vs. 62.9 and 66.3 years; p < 0.001) and have higher BMI (34.9 vs. 33 and 31.7; p < 0.001) (most disadvantaged vs. middle and least). Analysis revealed no difference in rate of MUA (6.3 vs. 2.5 vs. 4 %; p = 0.179) or postoperative ROM (98 vs. 98 vs. 100°; p = 0.753) between the three groups (most, middle, and least disadvantaged, respectively). ConclusionNeighborhood socioeconomic disadvantage does not predict rate of MUA or postoperative ROM following TKA. Patients residing in neighborhoods with higher ADI who underwent TKA were more likely to be younger, Women, and have higher BMI, consistent with previous literature. Our results support efforts to improve access to orthopaedic care, including TKA, to patients of all socioeconomic levels.

Breastfeeding duration and brain-body development in 9-10-year-olds: modulating effect of socioeconomic levels.

To investigate relationships of breastfeeding duration with brain structure and adiposity markers in youth and how these relationships are modified by neighborhood socioeconomic environments (SEEs). This was a cross-sectional study of youth enrolled in the Adolescent Brain and Cognitive Development (ABCD) Study® (n = 7511). Mixed effects models examined associations of breastfeeding duration with global brain measures and adiposity markers, adjusting for sociodemographic, pre- and post-natal covariates. Stratified analysis was performed by area deprivation index (ADI) tertiles. Total cortical surface area (SA) (False Discovery Rate - FDR corrected P < 0.001), cortical (FDR corrected P < 0.001) and subcortical gray matter (GM) volume (FDR corrected P < 0.001) increased with increased breastfeeding duration. Body mass index (BMI) z-scores (FDR corrected P = 0.001), waist circumference (FDR corrected P = 0.002) and waist-to-height ratio (WHtR) (FDR corrected P = 0.001) decreased with increased breastfeeding duration. Breastfeeding duration was inversely associated with adiposity in youth from high- and medium- ADI neighborhoods, but positively associated with SA across ADI tertiles. In this cross-sectional study, longer breastfeeding duration was associated with lower adiposity indices, particularly in youth from lower SEEs and greater SA across SEE levels. Longer breastfeeding duration showed long-term associations with brain and body development for offspring. Building on previous findings that longer breastfeeding duration is associated with healthier weight gain, lower obesity risk, and brain white matter development in infancy, our results find longer breastfeeding duration to be associated with lower adiposity indices and greater cortical and subcortical gray matter volume, and cortical surface area during peri-adolescence. Children from lower socioeconomic environments (SEEs) demonstrated stronger negative associations of breastfeeding duration and adiposity indices, and children across SEEs showed positive relationships between breastfeeding duration and cortical surface area. Promoting breastfeeding, particularly among women from lower SEEs would confer long-term benefits to offspring.

Factors Associated With Tobacco Cessation Advice Recall and Quit Rates in Vascular Surgery Patients. A Single Center Study.

Smoking is an important modifiable risk factor in all vascular diseases and verbal advice from providers has been shown to increase rates of tobacco cessation. We sought to identify factors that will improve tobacco cessation and recall of receiving verbal cessation advice in vascular surgery patients at a single institution. The study is a retrospective cohort study. Patients seen in outpatient vascular surgery clinic who triggered a tobacco Best Practice Advisory (BPA) during their office visits over a 10-month period were contacted post-clinic and administered surveys detailing smoking status, cessation advice recall, and validated scales for nicotine dependence and willingness to quit smoking. This BPA is a "hard stop" that requires providers to document actions taken. Charts were reviewed for tobacco cessation documentation. Nine-digit zip-codes identified the area deprivation index, a measure of socioeconomic status. Univariate analysis was used to identify factors associated with cessation and advice recall. One hundred out of 318 (31.4%) patients responded to the survey. Epic Slicer Dicer found 97 BPA responses. To dismiss the BPA, 89 providers (91.8%) selected "advised tobacco cessation" and "Unable to Advise" otherwise. Of the 318 patients, 115 (36.1%) had cessation intervention documented in their provider notes and 151 (47.5%) received written tobacco cessation advice. Of survey respondents, 70 recalled receiving verbal advice, 27 recalled receiving written advice, 28 reported receiving offers of medication/therapy for cessation. 55 patients reported having tobacco cessation plans, and among those 17 reported having quit tobacco. Recall of receiving written advice (P < .001) and recall of receiving medication/therapy (P = .008) were associated with recall of receiving verbal cessation advice. Providing patients with tobacco cessation medication/therapy and written tobacco cessation education during office visits is associated with increased patients' recall of tobacco cessation advice. Vascular surgeons should continue to provide directed tobacco cessation advice.